Objective: To investigate the epidemiological characteristics and spatial-temporal clustering characteristics of scarlet fever in Jinhua City, Zhejiang Province from 2005 to 2023, so as to provide a reference for improving the prevention and control strategy of scarlet fever. Methods: The data of scarlet fever cases in Jinhua City from 2005 to 2023 were collected from the China Information System for Disease Control and Prevention, and descriptive epidemiological method was used to analyze the epidemiological characteristics of scarlet fever. The average annual percent change (AAPC) was calculated to analyze the trend of scarlet fever incidence from 2005 to 2023. The spatial-temporal clustering of scarlet fever was identified using spatial autocorrelation analysis and space-time scanning analysis. Results: A total of 1 494 scarlet fever cases were reported in Jinhua City from 2005 to 2023, and the average annual reported incidence rate was 1.41/100 000, with no significant change trend (AAPC=1.706%, P>0.05). There were two incidence peaks, from April to June and from November to January of the next year. There were 937 males and 557 females, with a male to female ratio of 1.68∶1. The age was mainly <10 years (1 391 cases, 93.11%), of which 3-<7 years was the high incidence age group (936 cases, 62.65%). There were 1 466 cases of preschool children, students, and scattered children, accounting for 98.13%. The average annual reported incidence of scarlet fever in Dongyang City, Pujiang County, and Yongkang City was 4.58/100 000, 3.04/100 000, and 1.99/100 000, respectively. The spatial autocorrelation analysis showed that there was a positive spatial correlation between the incidence of scarlet fever in Jinhua City from 2005 to 2023 (Moran's I=0.579, P<0.05), and the high-high clustering areas were mainly distributed in Dongyang City and Pujiang County. The spatial-temporal scanning analysis showed that there were 8 spatial-temporal clustering areas of scarlet fever in Jinhua City from 2005 to 2023. The class Ⅰ clustering area was 9 towns in Dongyang City, and the clustering period was from August 2013 to December 2022. There were 7 class Ⅱ clusters, covering some streets in Pujiang County, Dongyang City, Yongkang City, Yiwu City, and Pan'an County. Conclusions From 2005 to 2023, the incidence of scarlet fever in Jinhua City was relatively low, and children aged 3-<7 years had a high incidence, and there was a spatiotemporal clustering. The peak incidence was from April to June and from November to January of the next year. Dongyang City, Pujiang County, and Yongkang City had high incidence areas.

Objective: To analyze the epidemiological characteristics of leptospirosis in Jinhua City, Zhejiang Province, from 2007 to 2024, so as to provide a basis for improving the prevention and control strategies of leptospirosis. Methods: Data pertaining to leptospirosis cases in Jinhua City from 2007 to 2024 were collected through the Monitoring and Reporting Management System of the Chinese Disease Prevention and Control Information System. Descriptive epidemiological methods were used to analyze the distribution characteristics of leptospirosis in terms of time, region, population, interval from the onset of the disease to diagnosis and the outbreak of the epidemic. Results: A total of 81 cases of leptospirosis were reported in Jinhua City from 2007 to 2024, with an average annual reported incidence of 0.08/100 000. The peak incidence occurred from August to September, with 57 cases accounting for 70.37%. Leptospirosis cases were reported in 9 counties (cities, districts) in Jinhua City. Pan'an County reported the most cases, with 52 cases accounting for 64.20%. There were 54 male cases and 27 female cases, with a male-to-female ratio of 2∶1. The majority of cases were aged over 40 years, with 73 cases accounting for 90.12%. The average reported incidence of leptospirosis showed an upward trend with the increase of age (P<0.05), and the highest incidence of leptospirosis was at the 60-<80 age group (0.21/100 000). The majority of patients were farmers, with 77 cases accounting for 95.06%. The median interval from onset to diagnosis was 4.00 (interquartile range, 6.00) days. There were significant differences in the interval from onset to diagnosis among cases in Dongyang City compared with Pan'an County, Wuyi County, and Wucheng District, between Pan'an County and Jindong District, Wucheng District, and between Wuyi County and Wucheng District (all P<0.05). In 2007, one outbreak of leptospirosis was reported, which occurred in Jiuhe Township, Pan'an County, with 36 reported cases. Conclusions The reported incidence of leptospirosis in Jinhua City from 2007 to 2024 is generally low. The high-incidence period is from August to September, and Pan'an County is the high-incidence area. Males over 40 years and farmers are the key populations for prevention and control. It is recommended to strengthen epidemic surveillance and health education for high-risk populations.

Objective To investigate the effect of esketamine on postoperative depression in frail elderly patients undergoing thoracoscopic radical resection of lung cancer.Methods A total of 88 frail elderly patients undergoing elective thoracoscopic radical resection of lung cancer were assigned randomly(using a randomization table)and in a double-blind way(blinding applies to both researchers and patients)to an esketamine group(Esk group,n=44)and a normal saline group(NS group,n=44).In the Esk group,0.25 mg/kg esketamine was injected intravenously during anesthesia induction,followed by continuous infusion of esketamine at 0.125 mg/kg per hour until 20 min before the end of surgery.In the NS group,equivalent volumes of normal saline were administered using the same method.The primary outcome was the score for the 17-item Hamilton Rating Scale for Depression(HAMD-17)on days 7 and 30 after surgery.The secondary outcomes included sleep quality and cognitive function.Sleep quality was assessed using the numerical rating scale(NRS)on days 1,3,and 7 after surgery and the Pittsburgh Sleep Quality Index(PSQI)on day 30 after surgery.Cognitive function was assessed using the Mini-Mental State Examination(MMSE)on days 1,3,7,and 30 after surgery.The other indicators included the levels of serum brain-derived neurotrophic factor(BDNF),5-hydroxytryptamine(5-HT),S100β protein,and neuron specific enolase(NSE)at 24 hours(T1),48 hours(T2),and 72 hours(T3)after surgery,as well as perioperative data and postoperative safety outcomes.Results Three patients were excluded from the Esk group and the NS group,respectively,and eventually,41 patients in each group were included in the statistical analysis.There were no statistically significant differences between the two groups in terms of age,sex,body mass index,American Society of Anesthesiologists(ASA)classification,comorbidities,educational attainment,and the scores for HAMD-17,PSQI,and MMSE 1 day before surgery(P＞0.05).Concerning the primary outcome,compared with those of the NS group,the HAMD-17 scores of patients in the Esk group were significantly lower at 7 days(median[P25,P75])(7[6,8]vs.7[6,12],P=0.045)and 30 days(6[6,7]vs.7[6,9],P=0.020)after surgery.Concerning the secondary outcomes,compared with those of the NS group,the sleep NRS scores of patients in the Esk group were significantly lower at 1,3,and 7 days after surgery(P＜0.01),and the MMSE scores were significantly higher(P＜0.05).Concerning the other indicators,compared with those of the NS group,the concentrations of serum BDNF and 5-HT in the Esk group were significantly higher(P＜0.05 or 0.01)at T1-T3,while the content of S100β was significantly lower(P＜0.01)at T1-T3;the levels of serum NSE were significantly lower at T1 and T2(P＜0.01);the consumption of propofol,sufentanil,remifentanil,and sevoflurane during surgery in the Esk group was significantly reduced(P＜0.05 or 0.01);the incidence of postoperative nausea/vomiting and hyperalgesia was significantly lower(P＜0.01);the duration of postoperative mechanical ventilation,length-of-stay in postanesthesia care unit(PACU),and postoperative length-of-stay in the hospital were significantly shorter(P＜0.01).Conclusion Esketamine can improve the postoperative depressive state,sleep quality,and cognitive function in frail elderly patients undergoing thoracoscopic radical resection of lung cancer.

Objective:To understand the consultation for post-exposure prophylaxis(PEP) services and their related factors among college students who were at high risk for HIV infection in Hangzhou,and to provide a reference basis for formulating an intervention model for college students at high risk of HIV infection.Methods:A cross-sectional survey was conducted between November 2022, and March 2023, in 5 different types of schools in Hangzhou. The subjects should meet the inclusion criteria of age between 18 years and 24 years old self-reported having ever had sex in the past. The sample size was estimated at 864. An online survey was conducted among college students by questionnaire star of an online survey platform to collect their demographic information, sexual behavior characteristics, HIV test status, and consultation for PEP services. The HIV infection risk among participants was evaluated according to their sexual behavior. The consultation for PEP services and the related factors of college students who were at high risk for HIV infection were analyzed.Results:A total of 20 973 college students were surveyed, and 2 291 who have ever had sex were recruited in the study. The proportion assessed as being at high risk for HIV infection was 43.47% (996/2 291), and the proportion of consultation for PEP services was 9.24% (92/996). Multivariate logistic regression analysis showed that among college students who were at high risk for HIV infection, the positive related factors of consultation for PEP services included knowing about PEP services (a OR=17.49, 95% CI: 7.98-38.36) ,having HIV tests (a OR=3.92, 95% CI: 2.08-7.42) and access to condoms on campus (a OR=3.38, 95% CI: 2.02-5.65), and the negative related factor was homosexual orientation (a OR=0.24, 95% CI: 0.06-0.91). Conclusions:Among college students who were at high risk for HIV infection, the proportion of consultation for PEP services was at a lower level. It is necessary to strengthen further the health education of PEP services knowledge among college students, improve the PEP services system, and promote the utilization of PEP services to reduce new HIV infections among college students.

Objective:To analyze the utilization of pre-exposure prophylaxis (PrEP) service against HIV and related factors in young men who have sex with men (MSM) in Hangzhou.Methods:A cross-sectional study design was used in this questionnaire survey in young MSM recurited through local MSM social organization in Hangzhou from September 2022 to March 2023. The estimated sample size was 242. The information about the social-demographic characteristics, behavioral characteristics, utilization of the post exposure prophylaxis (PEP) service, awareness and utilization of PrEP service of the young MSM were collected. Logistic regression model was used to analyze the related factors of the PrEP utilization.Results:A total of 273 young MSM aged 16- 24 years were surveyed in the study. A total for 20.1% (55/273) of them had used PrEP service. Multivariate logistic regression analysis showed that the factors related to PrEP service utilization included age 16-20 years (a OR=3.03, 95% CI:1.12-8.20), education level of senior high school or below (a OR=2.83, 95% CI:1.09-7.35), full-time/part-time work (a OR=3.25, 95% CI: 1.26-8.38), homosexual activity in the past 6 months (a OR=6.71, 95% CI:1.84-24.55), inquiring medical staff about PrEP (a OR=4.71, 95% CI:1.99-11.13) and PEP service use (a OR=6.09, 95% CI:2.69-13.81). Conclusions:The utilization rate of PrEP service was low in young MSM in Hangzhou. It is necessary to strengthen the health education about PrEP and improve the undertanding of PrEP and service capability of medical staff to promote the utilization of PrEP service in young MSM.

Objective:To understand the consultation for post-exposure prophylaxis(PEP) services and their related factors among college students who were at high risk for HIV infection in Hangzhou,and to provide a reference basis for formulating an intervention model for college students at high risk of HIV infection.Methods:A cross-sectional survey was conducted between November 2022, and March 2023, in 5 different types of schools in Hangzhou. The subjects should meet the inclusion criteria of age between 18 years and 24 years old self-reported having ever had sex in the past. The sample size was estimated at 864. An online survey was conducted among college students by questionnaire star of an online survey platform to collect their demographic information, sexual behavior characteristics, HIV test status, and consultation for PEP services. The HIV infection risk among participants was evaluated according to their sexual behavior. The consultation for PEP services and the related factors of college students who were at high risk for HIV infection were analyzed.Results:A total of 20 973 college students were surveyed, and 2 291 who have ever had sex were recruited in the study. The proportion assessed as being at high risk for HIV infection was 43.47% (996/2 291), and the proportion of consultation for PEP services was 9.24% (92/996). Multivariate logistic regression analysis showed that among college students who were at high risk for HIV infection, the positive related factors of consultation for PEP services included knowing about PEP services (a OR=17.49, 95% CI: 7.98-38.36) ,having HIV tests (a OR=3.92, 95% CI: 2.08-7.42) and access to condoms on campus (a OR=3.38, 95% CI: 2.02-5.65), and the negative related factor was homosexual orientation (a OR=0.24, 95% CI: 0.06-0.91). Conclusions:Among college students who were at high risk for HIV infection, the proportion of consultation for PEP services was at a lower level. It is necessary to strengthen further the health education of PEP services knowledge among college students, improve the PEP services system, and promote the utilization of PEP services to reduce new HIV infections among college students.

Objective:To analyze the utilization of pre-exposure prophylaxis (PrEP) service against HIV and related factors in young men who have sex with men (MSM) in Hangzhou.Methods:A cross-sectional study design was used in this questionnaire survey in young MSM recurited through local MSM social organization in Hangzhou from September 2022 to March 2023. The estimated sample size was 242. The information about the social-demographic characteristics, behavioral characteristics, utilization of the post exposure prophylaxis (PEP) service, awareness and utilization of PrEP service of the young MSM were collected. Logistic regression model was used to analyze the related factors of the PrEP utilization.Results:A total of 273 young MSM aged 16- 24 years were surveyed in the study. A total for 20.1% (55/273) of them had used PrEP service. Multivariate logistic regression analysis showed that the factors related to PrEP service utilization included age 16-20 years (a OR=3.03, 95% CI:1.12-8.20), education level of senior high school or below (a OR=2.83, 95% CI:1.09-7.35), full-time/part-time work (a OR=3.25, 95% CI: 1.26-8.38), homosexual activity in the past 6 months (a OR=6.71, 95% CI:1.84-24.55), inquiring medical staff about PrEP (a OR=4.71, 95% CI:1.99-11.13) and PEP service use (a OR=6.09, 95% CI:2.69-13.81). Conclusions:The utilization rate of PrEP service was low in young MSM in Hangzhou. It is necessary to strengthen the health education about PrEP and improve the undertanding of PrEP and service capability of medical staff to promote the utilization of PrEP service in young MSM.

Objective To explore the application of polysomnography combined with arterial spin labeling(ASL)perfusion magnetic resonance imaging in the diagnosis of insomnia.Methods Forty-two insomnia patients admitted to Department of Neurology were included as insomnia group,while 41 healthy subjects during the same period were included as control group.The two groups were assessed using sleep habits questionnaire,hospital anxiety and depression scale,polysomnography,and ASL perfusion magnetic resonance imaging.Results Compared with control group,insomnia group took significantly more time to fall asleep(P<0.05),and has shorter sleep duration(P<0.05).The differences in the levels of anxiety and depression between two groups were trivial.The total sleep time,rapid eye movement sleep duration,and non-rapid eye movement sleep stage S2-S4were shorter,while the sleep latency and non-rapid eye movement sleep stage S1were longer in insomnia group as compared with control group(all P<0.05).In insomnia group,perfusion was increased in bilateral prefrontal lobes,right temporal lobe,left parietal lobe,right thalamus,and pons(P<0.05),but decreased in bilateral insula and bilateral basal ganglia(P<0.05).Conclusion The combination of polysomnography and ASL perfusion magnetic resonance imaging enables precise quantification of sleep condition.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective: To examine the association between leukocyte telomere length and cataract using bidirectional Mendelian randomization (MR) approach, so as to provide the basis for early diagnosis and prevention of cataracts. Methods: Leukocyte telomere length data were collected through a meta analysis of genome-wide association studies (GWAS), including 78 952 participants, and the GWAS data of cataract were collected through the UK Biobank, including 8 890 cases and 454 120 controls. A bidirectional MR analysis was performed using the inverse-variance weighted (IVW) method, and single nucleotide polymorphisms (SNPs) which were associated with leukocyte telomere length were selected as instrumental variables. The heterogeneity was assessed using the Cochran's Q test, the horizontal pleiotropy was assessed using the MR-Egger regression and the outlier was verified with the leave-one-out and MR-PRESSO test. Results: Forward MR analysis results showed that shortened leukocyte telomere length had an increased risk of cataract (OR=0.991, 95%CI: 0.990-0.997). Reverse MR analysis results showed no statistically significant association between leukocyte telomere length and cataract (P>0.05). Cochran's Q test detected no heterogeneity, and neither the MR-Egger regression nor the MR-PRESSO test revealed horizontal pleiotropy of instrumental variables (both P>0.05). Leave-one-out analysis showed robustness of the MR analysis results. Conclusion Shorter leukocyte telomere length might be associated with increased risk of cataract.